Imagine that your husband is coming home today. You haven’t seen him in the year since he left your small village to work in diamond mines 200 miles away. He left because farming wasn’t yielding enough food to feed the family. You’re almost certain that he wasn’t faithful during his time away. You missed him! But you’re scared. Especially because you know you can’t ask him to use a condom.

Your experience is that of millions of women throughout the world, who have little or no control over their own reproductive health.

As the HIV/AIDS pandemic continues to evolve, it is becoming increasingly clear that women are more vulnerable than men. In 1997, 41% of the adults infected with HIV/AIDS were women; by 2005 this number had risen to 46%. Socioeconomic and biological factors contribute to this trend, but gender politics plays a role as well. Current approaches to HIV/AIDS prevention have not been effective enough, particularly for wives whose husbands already have AIDS. To reduce women’s vulnerability and provide them their own tool for prevention, a microbicide is needed.

A microbicide is a topical gel, cream, suppository, film, or ring that is designed to prevent the sexual transmission of HIV and other STDs. Ideally, it would be scentless and virtually undetectable to a woman’s sexual partner, granting the woman complete control. Currently, there are no microbicides available on the market, although about sixty products are currently under development, including eleven now in human clinical trials. If one of these products proves effective, and if sufficient funding materializes, a microbicide could hit the market in five to seven years. Even conservative models predict that introducing microbicides to developing countries could prevent 2.5 million HIV infections in as little as three years.

HIV prevention strategies currently in favor promote abstinence, monogamy, and male condom use. None of these methods, however, provide a realistic solution for the millions of women around the world that engage in transactional sex in order to survive. Prostitution is often the only option for women to support themselves and their families. Less criminal but equally problematic are the relationships into which young women enter with older men or “sugar daddies,” who often help them with tuition, groceries, or other living expenses in exchange for sex. We cannot rely on men to use condoms in these situations, and even in more even-handed relationships abstinence is not always a realistic option. A microbicide would give women the means to control their own sexual health without their partners’ knowledge.